Provider First Line Business Practice Location Address:
200 PLAZA COURT
Provider Second Line Business Practice Location Address:
SUITE B 447 OFFICE PLAZA
Provider Business Practice Location Address City Name:
EAST STROUDSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-421-4276
Provider Business Practice Location Address Fax Number:
570-421-5016
Provider Enumeration Date:
07/21/2005